Question

John is a 30-year old married male who feels down most of the time. He experiences frequent, intrusive thoughts that he is not good enough, despite personal and professional successes. He tries to overcompensate for his thoughts by taking on more than he can handle, which leads to failure and furthers his feelings of inadequacy. He reported the following to his therapist: “I feel pretty worthless and have felt that way for a long time - for over ten years. It feels normal to be down. Sometimes I start to feel better, but it never lasts - I feel bad about my life most of the time. I don’t think that I’ll amount to anything and l might never be successful at work. I feel exhausted all of the time. I have trouble sleeping. I’ve been waking up in the middle of the night and can’t stop thinking about all of my failures. Maybe I’m just pessimistic.”

A
Generalized Anxiety Disorder
B
Major Depressive Disorder
C
Persistent Depressive Disorder
D
Premenstrual Dysphoric Disorder
E
Bipolar I Disorder
F
Bipolar II Disorder
G
Cyclothymic Disorder
H
Postpartum Depression
I
Major Depressive Disorder, Peripartum Onset
J
None of these

Answer 1

The correct option is option C. Persistent Depressive Disorder.

Persistent Depressive Disorder (PDD) is a chronic form of depression but is usually said to be less severe. This diagnosis is appropriate for John because he has been experiencing depressive symptoms for over ten years and in order to be diagnosed with PDD, the symptoms must be present for two years. Also, John finds these symptoms to be his new normal which means he is experiencing depression nearly all the time. John's symptoms are chronic over the time but are less severe than the ones in Major Depressive Disorder.

Generalised anxiety is incorrect because John is not seen to be anxious or worried but is rather sad and hopeless all the time. Major Depressive Disorder is incorrect here because people with this disorder can experience normal baseline of mood when they are not feeling depressed. Also, depression is diagnosed after a period of two weeks and if the depressive symptoms stay for longer than two years, then it is Persistent Depressive Disorder. Premenstrual Dysphoric Disorder is a disorder similar to Premenstrual Syndrome that women face before their menstrual cycle but is more serious. Thus, John cannot be experiencing Premenstrual Dysphoric Disorder. Bipolar I and Bipolar II Disorders are also incorrect because in both of the disorders there is a manic episode that takes place along with depression which is not seen in the case of John. Cyclothymic Disorder is a disorder that involves emotional highs and lows that are somewhat less severe than the ones in bipolar disorders and since John usually doesn't experience any emotional highness, he cannot be diagnosed with Cyclothymic Disorder. Lastly, Postpartum Depression is experienced by women after their delivery of the child and Major Depressive Disorder with Peripartum Onset is experienced by pregnant women in the early months of their pregnancy and thus John cannot be diagnosed with either of the two.